Psycho-Surgery: From Cut to Cute

16. July 2010

The days of deep cuts in the brain in cases of psychoses and depressiveness are over. Very carefully, surgeons venture to cure psychic disorders with probes, laser and current pulses. The success rates are quite remarkable.

35 years ago, Jack Nicholson showed the really dark side of psycho-surgery. In his probably most popular movie “One Flew Over the Cuckoo’s Nest“ physicians are allowed to do whatever they want to the brain of the trouble maker and make him shut up by lobotomy. Walter Freeman writes: “This is how you smash imagination, blunt emotions, destroy any abstract thinking and create a robotic, controllable individual.” The “successes” of the former star-psychotherapist Freeman with lobotomy as an effective tool against pain, depressions and psychoses left ten thousands of patients behind without an own will in the fifties of the last century. Only fifty years later neurosurgeons started once again and very carefully to treat psychological disorders with a scalpel.

Healed with a Gamma-Knife

The new representatives of psychosurgery are very careful and strict in selecting their patients. Only if drugs, talks or behavior therapies fail, they start taking a surgery in the inner skull into consideration. The success rate is not that high yet to be able to forecast this discipline a blooming future. But for Gerry Radano this surgery meant the return to a normal life. An obsessive compulsive disorder which caused her to keep her body clean from all threats of the environment brought her into three psychiatric hospitals and nearly destroyed her family. She was saved by a surgery with the Gamma-Knife. The ‘bundled rays’ scalpel destroys targeted nerve tracts in the capsula interna. Today Gerry Radano is doing well. She wrote about her experiences and the process of her disorder in her book “Contaminated”.

There is good news from America as well as Germany about the treatment of Obsessive Compulsive Disorders (OCD). Instead of just cutting the nerve tracts between thalamus and frontal lope as done in earlier years, the methods became a lot more sophisticated. During the stereo tactic surgery, the surgeon enters probes into the according regions and severs only few important connections with either heat or cold.

Deep brain stimulations against tics

More and more, the brain pacemaker is applied. It is used for patients with morbus Parkinson for several years already and now physicians start implementing this electronic impulse provider with electrodes in patients with severe depressions and anxiety disorders. Peter Tass at the research center in Juelich/Germany had observed a regular rhythmic activity in the nucleus accumbens of a patient with obsessive compulsive disorder. The electric impulses of the electrodes are to curb these pathological signals like a jamming transmitter. The huge advantage of the method: It is reversible. In case the adjustment or location of the electrode does not fit, the physicians can re-adjust or – worst case – turn the transmitter off.

Volker Sturm at the University Hospital in Cologne/Germany successfully treats people suffering from the Tourette-syndrome with this method. “In most cases we got a good grip on the tics with the deep brain stimulation method. The problems nearly vanished,” says the head of the hospital for stereotaxia and functional neurosurgery. “But most important of all we were able to improve the life quality of the patients significantly because they don’t have to suffer from the psychic consequences of the disease any more.” The success rate of treatment of depressions are at about 50 percent as published in the journal Biological Psychiatry and thus within the same range as the results of American and Canadian colleagues.

Genius by brain stimulation?

But the installation of the wires in the brain is not without risk. Two to four percent of the patients get an infection, 0.4 percent of the surgeries result in a hemorrhage. In the USA, at least one case is known of ablative irreversible surgery resulting in complete helplessness. A study by Christian Rück at the Karolinska Institute in Stockholm/Sweden shows that half of ODC patients still suffer from apathy or reduced self-control after surgery even if the OCD have improved significantly. A working group in Toronto/Canada describes in the Annals of Neurology a case with unexpected side effects though. The neurosurgeons implemented electrodes in the hypothalamus of a patient with severe overweight against his binge eating. The addiction did not get a lot better but all of a sudden the man had an extraordinary memory being able to remember incidents which happened many years ago. And his learning ability improved incredibly as well.

With an increasing success rate the number of psychosurgical operations might increase as well. After all, the possibility to improve the brain performance by applying a brain pacemaker is tempting also. Without years of training, a large expense of imaging technology and a lot of experience of the surgeons, the risk of failures and mutilations is preprogrammed. The memories of the horror of the lobotomy victims are still fresh in a lot of psychiatry professors’ minds. So one of them, Darin Doherty at Harvard University, warns: “If something goes wrong with these tests it might close the door for this therapy approach again for another century.”